{include file="public/header"/}



{include file="public/navleft"/}


<div class="tpl-content-wrapper" xmlns="http://www.w3.org/1999/html">
    <div class="tpl-content-page-title">
        用户详情表单
    </div>

    <div class="tpl-portlet-components">
        <div class="portlet-title">
            <div class="caption font-green bold">
                <span class="am-icon-code"></span> 表单
            </div>


        </div>
        <div class="tpl-block ">

            <div class="am-g tpl-amazeui-form">


                <div class="am-u-sm-12 am-u-md-9">


                    <div class="am-g" style="margin-left: 10%">
                        <div class="am-u-md-8 am-u-sm-centered" >
                            <form class="am-form" method="post" action="{:url('xmb/WbXmAdd')}">
                                <fieldset class="am-form-set">
                                    <span>当前项目代号 -小项(自动依次累计) -默认查询添加</span><input type="text" placeholder=""  name="{$data.xmdh}" value="{$data.xmdh|default=''}" >
                                    <span>当前项目编号 -默认查询添加</span><input type="text" placeholder=""  name="{$data.xmbh}"value="{$data.xmbh|default=''}">
                                    <span>当前组合代号-检验目的代号(自动依次累计)-默认查询添加</span><input type="text" placeholder=""  name="{$data.xmbh}"value="{$data.xmbh|default=''}">
                                    <span>新加项目名</span><input type="text" placeholder=""  name="{$data.xmmc}" value="{$data.xmmc|default=''}">
                                    <span>送检单位</span><input type="text" placeholder="" name ="{$data.Outhosiptal}" value="{$data.Outhosiptal|default=''}">
                                    <span>标本类型</span>
                                    <div class="am-form-group">

                                        <select id="doc-select-1" required>
                                            <option value="">请选择标本类型</option>
                                            <option value="option1">选项一...</option>
                                            <option value="option2">选项二.....</option>
                                            <option value="option3">选项三........</option>
                                        </select>
                                        <span class="am-form-caret"></span>
                                    </div>
                                    <span>是否允许pdf -是否 允许-'o'或者'1'--0为停用 1在用</span><input type="text" placeholder="" name ="status"value="1">

                                    <span>一级价格（最高）</span><input type="text" placeholder=""  name="{$data.xmbh}"value="{$data.xmbh|default=''}">
                                    <span>二级价格</span><input type="text" placeholder=""  name="{$data.xmmc}" value="{$data.xmmc|default=''}">
                                    <span>三级价格 (最优惠)</span><input type="text" placeholder="" name ="{$data.Outhosiptal}" value="{$data.Outhosiptal|default=''}">

                                    <div class="am-u-sm-9 am-u-sm-push-5">
                                        <button type="submit" class="am-btn am-btn-primary">确认增加</button>
                                    </div>
                                </fieldset>
                            </form>
                        </div>
                    </div>
                </div>


            </div>
        </div>

    </div>



</div>


{include file="public/footer"/}